Soft tissue fixation device

ABSTRACT

A device for attaching soft tissue to a prosthetic implant. The device includes a body that includes a frame and a porous section disposed within the frame, wherein the porous section permits the passage of body fluids therethrough to encourage the healing of the soft tissue as well as the growth of soft tissue into and through the porous section.

BACKGROUND OF THE INVENTION Field of the Invention

The present disclosure relates to a device for the retention of softtissue. More specifically, the present disclosure relates to a devicefor attaching soft tissue to a bone replacement device, such as to aproximal tibial implant.

Description of the Prior Art

When replacing a joint in a patient, it is preferable to maintainconnection of as much of the soft tissue as possible while replacing thearticulation surfaces of the bones, thereby preserving the flexor andextensor mechanisms of the joint. However, preservation of the softtissue connections is not always possible. This may occur, for example,in the case of oncological bone disease, revision surgery withsignificant bone loss, or a traumatic injury that requires resection andprosthetic reconstruction of the attachment points.

Resection of the portion of the bone that includes the soft tissueattachment points leaves the surgeon with the dilemma of attaching thesoft tissue to the prosthesis. Mechanical attachment of soft tissue tothe prosthesis is often accomplished via sutures or a clamp. However, inorder to achieve long term success, the ultimate goal is for there to bebiological fixation of the soft tissue to the prosthesis.

A technique currently utilized to achieve biological fixation of apatellar tendon to a proximal tibial implant is to first mechanicallyattach the tendon to the prosthesis with either sutures or a mechanicaldevice such as a clamp, and then cover the reconstruction with a medialor lateral gastrocnemius flap over the top of the remnant of thepatellar tendon and prosthesis. The gastrocnemius flap provides a softtissue closure under the skin and also provides additional blood supplyto the tendon. This additional blood supply can thereby promote tissuegrowth of the patellar tendon and biological fixation of the patellartendon to a surface of the proximal tibial implant. Similar techniquesare currently utilized to achieve biological fixation of tendons, ormuscles, or other soft tissues to prostheses in other joints, such asthe proximal femur and the shoulder. When performing these surgicaltechniques, the use of sutures to attach the tendon to the prosthesishas several downfalls. First, the sutures have minimal purchase in thetendon and can cause the tendon to tear at the points of contact,allowing the tendon to pull away from the prosthesis, making biologicalfixation difficult. Second, the process of attaching sutures is timeconsuming, and therefore, inefficient for the surgeon. Third, theconstruct is initially only as strong as the rupture strength of thesuture. The use of a mechanical device such as a clamp to attach thetendon to the prosthesis alleviates these issues. However, presentlyavailable clamps, while providing a larger purchase area, also preventthe healing factors provided by the gastrocnemius flap from reaching theportions of the tendon under the clamps, thereby reducing the likelihoodof biological fixation. The present disclosure provides a time-savingsoft tissue fixation device that enables a large, secure mechanicalattachment, and allows the healing factors to reach the entire portionof the tendon that is in contact with the prosthesis, thereby maximizingthe likelihood of achieving biological fixation of the tendon to theprosthesis.

SUMMARY OF THE INVENTION

The present disclosure provides devices and methods for fixation of softtissue to prosthetic implants. The soft tissues may include, but are notlimited to, ligaments, tendons, and/or muscles. The prosthetic implantsmay include prostheses for replacing all or a portion of any boneadjacent to a joint.

According to one exemplary embodiment, the soft tissue fixation deviceincludes a body with an anterior surface, a posterior surface, and adepth extending from the anterior surface to the posterior surface. Thebody also includes a distal end, a proximal end, and a height extendingfrom the distal end to the proximal end, as well as a lateral end, amedial end, and a width extending from the lateral end to the medialend. The posterior surface of the soft tissue fixation device has aconcave portion that generally matches a convex portion of an anteriorsurface of a prosthetic implant. The body of the soft tissue fixationdevice also includes a frame with a solid perimeter and a porous sectiondisposed within the solid perimeter of the frame. The porous sectionextends through the depth of the body so the anterior surface is incommunication with the posterior surface through the porous section. Theporous section extends across a majority of the height and width of thebody of the soft tissue fixation device.

The soft tissue fixation device may be secured to the prosthetic implantusing one of several securing structures. The securing structures mayinclude medial and lateral attachment openings extending from theanterior surface to the posterior surface and a cable configured tofirst pass through one of the openings and a corresponding lateral ormedial channel in the prosthetic implant extending from an anteriorsurface to a posterior surface of the prosthetic implant. The cable isconfigured to then be passed through the other channel and attachmentopening. The trailing end of the cable includes a protrusion that islarger than the openings. The device also includes a crimp configured tobe attached to the cable adjacent to the lateral or medial opening thecable exits, wherein the crimp is larger than the opening.

The securing structures may also include medial and lateral attachmentposts with flat surfaces for engagement with medial and lateral setscrews. The attachment posts extend from the posterior surface proximatethe medial and lateral ends. The medial and lateral attachment posts areconfigured to fit within medial and lateral attachment openings in theprosthetic implant. It should be noted that the device may besymmetrical, enabling the posts to be interchangeably utilized in eitheropening, or the device may be asymmetrical.

Another exemplary embodiment discloses a tibial orthopedic implantincluding a proximal tibial component and a soft tissue attachmentdevice. The proximal tibial component is configured to attach to andextend from a resected proximal tibia. The proximal tibial componentincludes a body having an anterior surface, a posterior surface, amedial side, a lateral side, a distal end, and a proximal end. Theanterior surface includes a porous section configured to allow tissueingrowth. The porous section has a convex curvature extending fromproximate the medial side to proximate the lateral side. The body alsoincludes a plurality of openings adjacent the porous section. Theproximal tibial component also includes an articulation componentconfigured to attach to the proximal end of the body and includes abearing surface configured to bear against a distal femoral implant. Theimplant also includes a soft tissue attachment device that has ananterior surface, a posterior surface, and a depth extending from theanterior surface to the posterior surface. The soft tissue attachmentdevice also has a distal end, a proximal end, and a height extendingfrom the distal end to the proximal end, and a lateral end, a medialend, and a width extending from the lateral end to the medial end. Theposterior surface of the soft tissue attachment device has a concaveportion that generally matches the convex curvature of the poroussection of the body of the proximal tibial component. The soft tissueattachment device further includes a frame with a solid perimeter and aporous section disposed within the solid perimeter. The porous sectionextends through the depth of the soft tissue attachment device so theanterior surface is in communication with the posterior surface throughthe porous section. Also, the porous section extends across a majorityof the height and width of the soft tissue attachment device.

These and other objects of the present invention will be apparent fromreview of the following specification and the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute apart of the specification, illustrate preferred embodiments of theinvention and, together with the description, serve to explain theobjects, advantages, and principles of the invention.

FIG. 1A is a perspective view of a soft tissue attachment device inaccordance with an exemplary embodiment of the present invention;

FIG. 1B is a perspective view of a soft tissue device in accordance withanother exemplary embodiment of the present invention;

FIG. 2 is a perspective view of the soft tissue attachment device inFIG. 1A in combination with a proximal tibial component in accordancewith an exemplary embodiment of the present invention;

FIG. 3 is an exploded perspective view of the embodiment of FIG. 2;

FIG. 4 is a front elevation view of the embodiment of FIG. 2;

FIG. 5 is a side elevation view of the embodiment of FIG. 2;

FIG. 6 is a perspective view of a soft tissue attachment device inaccordance with another exemplary embodiment of the present invention;

FIG. 7 is a side elevation view of the soft tissue attachment device inof FIG. 6 in combination with a proximal tibial component in accordancewith another exemplary embodiment of the present invention;

FIG. 8 is a perspective view of a soft tissue attachment device inaccordance with another exemplary embodiment of the present invention;

FIG. 9 is a top plan view of the soft tissue attachment device of FIG.8;

FIG. 10 is a perspective view of a soft tissue attachment device inaccordance with another exemplary embodiment of the present invention;

FIG. 11 is a perspective view of a soft tissue attachment device inaccordance with another exemplary embodiment of the present invention;

FIG. 12 is a perspective view of a soft tissue attachment device inaccordance with another exemplary embodiment of the present invention;

FIG. 13 is a perspective view of a soft tissue attachment device inaccordance with another exemplary embodiment of the present invention;

FIG. 14 is a top plan view of the soft tissue attachment device in FIG.13;

FIG. 15 is a perspective view of a soft tissue attachment device inaccordance with another exemplary embodiment of the present invention;

FIG. 16 is a front perspective view of a soft tissue attachment devicein accordance with another exemplary embodiment of the presentinvention;

FIG. 17 is a rear perspective view of the soft tissue attachment devicein FIG. 16; and

FIG. 18 is a perspective view of a soft tissue attachment device inaccordance with another exemplary embodiment of the present invention.

FIG. 19 is a perspective view of a soft tissue attachment device inaccordance with another exemplary embodiment of the present invention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

The detailed description of the invention, below, is described, andshown in the figures, for use with a proximal tibial component. However,it should be understood that the invention could be used for securingany soft tissue to any implant or joint replacement device in a patient.

Referring to FIGS. 1-5, soft tissue attachment device 100 is used tomechanically attach a patellar tendon of a patient to proximal tibialcomponent 200 while allowing blood and other joint fluids to reach themechanically attached tendon after the soft tissue attachment device issecured to encourage biological fixation of the tendon to tibialcomponent 200. Further, the clamp will allow for soft tissue fixation oringrowth in a similar fashion to that of the tibial component 200.Device 100 includes body 101 which includes two parts, frame 120 andporous section 110. Frame 120 and porous section 110 may be made of asingle material, such as titanium, stainless steel, tantalum,cobalt-chrome, tungsten or any other biocompatible material, or compoundmaterial, such as for example titanium coated PEEK, suitable for humanimplantation. If porous section 110 and frame 120 are made of the sametype of material, then it is preferred, although not necessary, thatthey are unitary for enhanced structural purposes. Alternatively, poroussection 110 and frame 120 may be made of different materials. Poroussection 110 may be made of any porous material that will readily permitthe passage of bodily fluids or soft tissue therethrough, includingceramics, metals, polymers, and combinations thereof. Furthermore,porous section 110 may be formed of lattice 111 made of horizontally andvertically aligned strips, or strips in any other orientation, havingwide or narrow spacing. Alternatively, lattice 111 may serve as asupport structure for another porous material that covers and isattached to lattice 111. In this configuration, the horizontal andvertical strips are used more for structural support, as the poroussection is optimized for soft tissue ingrowth. The porous structure canbe created from standard geometric shapes such as dodecahedrons oroctahedrons that are stacked to create a pore size between 500-700microns and a porosity of 60-80%. This configuration can be ordered orrandomized. The preferred pore size mentioned can be optimized forallowing soft tissue to grow into the construct to provide viable longterm biologic fixation. Further, by having the porous structure on theclamp, the tissue can also infiltrate the clamp and the underlyingprosthetic tibia. Additionally, the porosity and structure can beoptimized for bone or hard tissue ingrowth for the tibia or otherreplacement joints.

Body 101 of device 100 includes anterior surface 150, posterior surface151, and a depth between anterior surface 150 and posterior surface 151.Anterior surface 150 and posterior surface 151 are in communicationthrough porous section 110. Posterior surface 151 is configured tocontact and retain the patellar tendon against tibial component 200.Retention is accomplished by a clamping force applied to the tendonbetween device 100 and tibial component 200. However, applying excessiveforce to ensure retention can prevent blood flow to the tendon causingnecrosis of the tendon, and therefore, preventing the desired biologicalfixation. Accordingly, posterior surface 151 may include a frictionenhancing surface to increase mechanical retention under less clampingforce. The friction enhancing surface may include a roughened surface,barbs, teeth, or any other structure suitable to aid retention.

Body 101 of device 100 further includes distal end 131, proximal end130, and a height extending between distal end 131 and proximal end 130.Body 101 also includes lateral end 140, medial end 141, and a widthextending between lateral end 140 and medial end 141. Posterior surface151 of body 101 may be, at least in part, concave along the width ofbody 101, and anterior surface 150 may be convex along the width of body101. As will be appreciated, the use of the terms medial and lateral todescribe the embodiments show in the figures describes an implant forthe left knee of a patient. The use of these terms, as well as any otherdirectional terms used throughout the specification and claims, whichare well known to those skilled in the art, is merely for convenience,and the terms should be considered interchangeable in the context ofrelative special relationships and other parts of a human body.

Device 100 may include lateral attachment post 160 extending fromposterior surface 151, proximate lateral end 140. Lateral attachmentpost 160 includes flat surface 170 along at least a portion of a lengththereof for engagement with lateral set screw 270. Device 100 mayfurther include medial attachment post 161 extending from posteriorsurface 151, proximate medial end 141. Medial attachment post 161includes flat surface 171 along at least a portion of a length thereoffor engagement with lateral set screw 271. While affixing device 100 totibial component 200 using set screws 270 and 271, the surgeon shouldapply and maintain the desired clamping force while tightening setscrews 270 and 271.

Referring to FIGS. 2-5, proximal tibial component 200 is configured tobe attached to, and extend proximally from, a resected proximal tibia ofa patient. Tibial component 200 includes a body 201 with anteriorsurface 250, posterior surface 251, lateral side 240, medial side 241,proximal end 230, and distal end 231. Anterior surface 250 includes aporous section 210. Porous section 210 is generally in the desiredlocation for the patellar tendon to achieve biological fixation. Poroussection 210 is made of material that permits ingrowth of soft tissue.Porous section 210 can be created from standard geometric shapes such asdodecahedrons or octahedrons that are stacked to create a pore sizebetween 500-700 microns and a porosity of 60-80%. This configuration canbe ordered or randomized. The preferred pore size mentioned is optimizedfor allowing soft tissue to grow into the construct to provide viablelong term biologic fixation. Additionally, the porosity and structurecan be optimized for bone or hard tissue ingrowth for the tibia or otherreplacement joints. Porous section 210 may be manufactured separatelyfrom body 201 and then mechanically attached to body 201 usingmechanical fasteners or by any other means known to those skilled in theart (not shown). If porous section 210 is manufactured separately frombody 201, porous section 210 may be made of a different material thanbody 201. When manufactured separately, porous section 210 may be madeof any ceramics, metals, polymers, or combinations thereof havingsuitable porosity to permit tissue ingrowth and structural integrity toserve as the anchor point of the extensor mechanism of the leg. However,preferably, the solid body 201 and porous section 210 are manufacturedas a unitary structure utilizing three-dimensional printing technology,which is well known in the art. If body 201 and porous section 210 are aunitary structure, they may be made of titanium, stainless steel,tantalum, cobalt chrome, tungsten or any other biocompatible material orcombination thereof suitable for human implantation having thestructural strength to carry the loads required of a prosthetic knee.

Body 201 of tibial component 200 further includes lateral attachmentopening 260 configured to receive lateral attachment post 160 therein.Lateral attachment opening 260 is in communication with threaded lateralset screw opening 272 to facilitate the engagement of lateral set screw270 with flat surface 170 on lateral attachment post 160. Body 201 alsoincludes medial attachment opening 261 configured to receive medialattachment post 161 therein. Medial attachment opening 261 is incommunication with threaded medial set screw opening 273 to facilitatethe engagement of medial set screw 271 with flat surface 171 on medialattachment post 161. Body 201 may also include a second pair of lateraland medial attachment openings 260, 261 and lateral and medial set screwopenings 272, 273 distal of the first pair to facilitate the use of asecond soft tissue attachment device 100.

Body 201 may further include a plurality of lateral openings 280 and aplurality of medial openings 281 to facilitate attachment of softtissue, such as either the patellar tendon or the gastrocnemius flap,via sutures to tibial component 200. Alternatively, body 201 may includeadditional structure to permit the use of addition soft tissueattachment devices to retain the desired soft tissues, such as thegastrocnemius flap.

Proximal tibial component 200 further includes an articulation component(not shown) configured to attach to proximal end 230. The articulationcomponent includes a bearing surface configured to bear against a distalfemur or a distal femoral implant (not shown).

FIGS. 6-7 show soft tissue attachment device 300. Device 300 is similarto device 100 except for the apparatus used to attach device 300 toproximal tibial component 400. Similar to device 100, device 300includes body 301 which has two parts, frame 320 and porous section 310.Body 301 of device 300 includes anterior surface 350, posterior surface351, distal end 331, proximal end 330, lateral end 340, and medial end341. Body 301 includes lateral attachment opening 370 which extends fromanterior surface 350 to posterior surface 351 and is located proximatelateral end 340. Body 301 also includes medial attachment opening 371which extends from anterior surface 350 to posterior surface 351 and islocated proximate medial end 341. It should be noted that device 300 mayinclude medial and lateral posts (not shown) similar to 170 and 171 ofdevice 100. The medial and lateral posts of device 300 are utilized toproperly align and stabilize device 300 relative to the prosthesis. Inthe embodiment including medial and lateral posts, the lateral andmedial openings 370, 371 extend longitudinally through the posts.

Attachment of device 300 is facilitated by cable 500. Cable 500 may bemade of a woven polymeric material or a monofilament wire. Cable 500includes protrusion 510 attached to a trailing end of cable 500.Protrusion 510 may be spherical, cylindrical, or conical. Protrusion 510has a larger maximum dimension than lateral attachment opening 370 so asto prevent protrusion 510 from passing through opening 370. Lateralattachment opening 370 may be countersunk so that a trailing end ofprotrusion 510 is flush with anterior surface 350 when installed. Aleading end of cable 500 is secured by a cable retention device (notshown) affixed to cable 500 adjacent to medial attachment opening 371.The cable retention device may be spherical, cylindrical, or conicalshape. The cable retention device has a maximum dimension larger thanmedial attachment opening 371 so as to prevent the cable retentiondevice from passing through opening 371. The cable retention device maybe a crimp which is constructed of a plastically deformable material,wherein the crimp is affixed to cable 500 by the application ofsufficient pressure to permanently deform the crimp around cable 500.The deformable crimp may have a slot on a side to permit the crimp toslide laterally onto cable 500, or the crimp may have a centralthru-hole permitting the crimp to be axially introduced on to cable 500prior to deformation. Alternatively, the cable retention device may beconstructed of a rigid material and include a thru-hole. The thru-holeincludes back-angled teeth that permit the cable retention device totravel along cable 500 from the leading end toward the trailing end, butprohibit movement from the trailing end toward the leading end. In yet afurther alternative, the retention device may have a set screw hole incommunication with the thru-hole, thereby permitting the introduction ofa set screw for the retention of the cable with respect to the cableretention device. In yet a further alternative, a crimped component canbe used to secure to cable 500 and prevent movement with the soft tissueattachment device by mating with opening 370 or 371. Medial attachmentopening 371 may be countersunk so that a trailing end of the cableretention device is flush with anterior surface 350 when installed.

FIG. 7 shows proximal tibial component 400 with device 300 attachedthereto. Proximal tibial component 400 is similar to proximal tibialcomponent 200. However, tibial component 400 need not include set screwholes. Tibial component 400 includes a body 401 with anterior surface450, posterior surface 451, lateral side 440, and a medial side (notshown). Anterior surface 450 includes a porous section 410. Body 401 oftibial component 400 further includes lateral attachment channel 460which extends from anterior surface 450 to posterior surface 451proximate lateral side 440 and is configured to receive cable 500therethrough. Body 401 of tibial component 400 also includes a medialattachment channel (not shown) which extends from anterior surface 450to posterior surface 451 proximate the medial side and is configured toreceive cable 500 therethrough. Cable 500 is configured to be insertedfirst through lateral attachment opening 370 then through correspondinglateral attachment channel 460. After exiting lateral attachment channel460, cable 500 is wrapped around posterior surface 451 and is passedthrough the medial attachment channel and medial attachment opening 371.After the leading end of cable 500 exits medial attachment opening 371,sufficient tension is applied to cable 500 to generate enough forcebetween device 300 and tibial component 400 to retain the patellartendon. The correct cable tension is then maintained by affixing thecable retention device to cable 500. Alternatively, body 401 may includea groove (not shown) extending from lateral attachment channel 460 tothe medial attachment channel along posterior surface 451. The grooveshould have a width and depth roughly equal to the diameter of cable 500so that when installed, cable 500 is flush with posterior surface 451.In another alternative, lateral attachment channel 460 does not exitposterior surface 451, and instead, curves around inside body 401 andconnects to the medial attachment channel, thereby forming onecontinuous channel beginning and ending on anterior surface 450. In afurther alternative, proximal tibial component 400 and device 300 may beconfigured to accept multiple cables 500 therethrough, including havingthe cables inserted from opposite directions.

FIGS. 8-18 show various different structures that may be utilized toaffix a soft tissue attachment device to a prosthesis. For claritypurposes, the prostheses are omitted from the figures. However, one ofordinary skill in the art would understand the corresponding structurerequired in the prostheses to accommodate the depicted structures. Whilenot shown in the figures, it should be understood that the embodimentsshown in FIGS. 8-18 may include a porous section. Also not shown in thefigures is the tibial component.

FIGS. 8 and 9 show soft tissue attachment device 100A which includesbody 101A. Body 101A includes anterior surface 150A, posterior surface151A, lateral end 140A, and medial end 141A. Similar to device 100,device 100A includes lateral attachment post 160A extending fromposterior surface 151A, proximate lateral end 140A. However, instead ofincluding a flat surface for engagement with a lateral set screw,lateral attachment post 160A includes gear teeth 180 disposed on themedial side thereof. Device 100A also includes medial attachment post161A which includes gear teeth 181 disposed on the lateral side thereof.Gear teeth 180, 181 are configured to engage threads 610 of worm screw600. Worm screw 600 is preinstalled within a cylindrical chamber insidea prosthesis wherein the cylindrical chamber is in communication withattachment openings configured to receive medial and lateral attachmentposts 160A and 161A. Worm screw 600 is rotated via torque applied by atool (not shown) inserted in drive opening 620. Drive opening 620 may beany suitable shape for receiving a rotational tool therein, for example,a Philips head, flat head, star key, allen key, etc. Drive opening 620is accessed through access opening 190 which extends from anteriorsurface 150A to posterior surface 151A. The prosthesis includes acorresponding access opening configured to be coaxially aligned withaccess opening 190 when attachment posts 160A and 161A are inserted intothe attachment openings in the prosthesis.

FIG. 10 shows soft tissue attachment device 100B which includes body101B. Body 101B includes anterior surface 150B, posterior surface 151B,lateral end 140B, and medial end 141B. These surfaces can represent anyof the same surfaces on the soft tissue attachment devices mentioned inthis application. Projections 192 are designed to be located on theposterior surface of the soft tissue attachment device to facilitateholding the soft tissue in place while relying on other means to affixthe device to the prosthesis. Each projection 192 includes barb 193angled back toward posterior surface 151B. Projections 192 are shorterthan the thickness of the soft tissue. It should also be understood thatbarbs 193 should face away from the direction of pull of the soft tissuebeing attached. In an alternative embodiment, some or all of projections192 could be made long enough to serve as the means of connecting device100B to the prosthesis. In such a configuration, the longer projections192 are longer than the thickness of the soft tissue and are configuredto pass through the soft tissue and into corresponding openings on theprosthesis. Barbs 193 are configured to deflect while projections 192pass into the corresponding openings on the prosthesis. After barbs 193pass through the corresponding openings, barbs 193 assume their originalconfiguration, preventing withdrawal of soft tissue attachment device100B from the prosthesis. Soft tissue device 100B and the prosthesis mayinclude alignment markings on the anterior surfaces 150B thereof tofacilitate alignment of the projections with the corresponding openingson the prosthesis. It may be advantageous to produce devices 100Bincluding different lengths of projections to accommodate varying softtissue thicknesses.

FIG. 11 shows soft tissue attachment device 100C which includes body101C. Body 101C includes anterior surface 150C, posterior surface 151C,lateral end 140C, and medial end 141C. Device 100C includes lateralattachment strap 160C extending from lateral end 140C and medialattachment strap 161C extending from medial end 141C. Medial attachmentstrap 160C includes gear teeth 180C disposed on an interior surfacethereof. Gear teeth 180C are configured to engage threads 610C of wormscrew 600C. Lateral attachment strap 141C includes gear teeth 181Cdisposed on an exterior surface thereof. Gear teeth 181C are configuredto engage gear threads 610C of worm screw 600C. Worm screw 600 ispreinstalled within a chamber inside a prosthesis wherein the chamber isin communication with attachment openings configured to receive medialand lateral attachment straps 160C and 161C or it may be externallycontained in a housing, the entire construct wraps around theprosthesis.

FIG. 12 shows soft tissue attachment device 100D which includes body101D. Body 101D includes anterior surface 150D, posterior surface 151D,lateral end 140D, and medial end 141D. Device 100D includes lateralattachment strap 160D extending from lateral end 140D and medialattachment strap 161D extending from medial end 141D. Medial attachmentstrap 160D includes tab 162D extending orthogonally therefrom. Tab 162Dincludes threaded opening 164D. Lateral attachment strap 141D includestab 163D extending orthogonally therefrom. Tab 163D includesnon-threaded opening 165D. Screw 600D is configured to be insertedthrough opening 165D into threaded opening 164D. Screw threads 610D areconfigured to cooperate with the threads of threaded opening 164D suchthat clockwise rotation of screw 600D causes screw 600D to linearlyadvance through threaded opening 164D, thereby causing screw head 622Dto contact tab 163D. Continued rotation of screw 610D will apply forceto tab 163 which causes posterior surface 151D to clamp down on the softtissue. Similar to the worm screw 600, screw 600D includes drive opening620D. Drive opening 620D may be any suitable shape for receiving arotational tool therein, for example, a Philips head, flat head, starkey, allen key, etc. Soft tissue attachment device 100D may bepreinstalled in a prosthesis such that attachment straps 140D, 141D andscrew are contained within the prosthesis and drive opening isaccessible through an opening in the prosthesis. Alternatively, theprosthesis may have a recess surrounding the prosthesis that permits themedial and lateral straps 160D, 161D to fit therein such that the outersurfaces of the straps are flush with, if not recessed to, the outsurface of the prosthesis. Soft tissue attachment device may alsoinclude a protrusion or peg disposed on the interior surface of eitheror both attachment straps 160D, 161D that fits into a correspondingdepression on the prosthesis to aid in positioning and attachment.

FIGS. 13 and 14 show soft tissue attachment device 100E which includesbody 101E. Body 101E includes anterior surface 150E, posterior surface151E, lateral end 140E, and medial end 141E. Similar to device 100,device 100E includes lateral attachment post 160E extending fromposterior surface 151E. However, instead of including a flat surface forengagement with a lateral set screw, lateral attachment post 160Eincludes a plurality of angled slots 180E extending therethrough. Device100E also includes medial attachment post 161E which includes angledslots 181E extending therethrough. Angled slots 180E, 181E areconfigured to receive posts 273E therein. Post 273E is pushed intoangled slot 181E by advancing screw 271E.

FIG. 15 shows soft tissue attachment device 100F. Device 100F includesanterior surface 150F, posterior surface 151F, lateral end 140F, medialend 141F, lateral attachment opening 160F, and medial attachment opening161F. Openings 160F, 161F may be configured to receive screws 600F, 601Fat any angle, in which case, screws 600F, 601F may be polyaxial screwswith generally spherical heads. Alternatively, openings 160F, 161F mayeach be configured to receive a screw at only a predetermined insertionangle. The predetermined insertion angles may be parallel, convergent,or divergent. A prosthesis for use with device 100F may include multiplethreaded holes at varying angles to accommodate the introduction ofscrews 600F, 601F. Alternatively, the prosthesis may include rotatableapparatuses, each with a single threaded opening capable of beingrotated to allow for varying insertion angles.

FIGS. 16 and 17 show soft tissue attachment device 100G which includesbody 101G. Body 101G includes anterior surface 150G, posterior surface151G, lateral end 140G, and medial end 141G. Similar to device 100,device 100G includes lateral attachment post 160G extending fromposterior surface 151G, proximate lateral end 140G. However, instead ofincluding a flat surface for engagement with a lateral set screw,lateral attachment post 160G is a partially threaded cylinder. Withinthe cylinder is a screw 271G configured to engage a trailing edge 274Gof a wedge 273G. Advancement of wedge 273G into box 275G (also locatedwithin lateral attachment post 160G) causes stops 276G to protrude fromopenings on the top and bottom of lateral attachment post 160G (notshown) and into corresponding slots 277G in the prosthesis, therebysecuring the device 100G to the prosthesis. Device 100G also includesmedial attachment post 161G extending from posterior surface 151G,proximate medial end 141G. Medial attachment post 161G includes arotatable shaft 280G disposed inside. The distal end of rotatable shaft280G includes a rectangular protrusion 281G. Rotation of rotatable shaft280G causes rectangular protrusion 281G to engage one of correspondingslots 287G located with the prosthesis. It should be noted that bothmedial attachment post 161G and lateral attachment post 160G may includethe structure shown and described for either of the posts 160G, 161G.

FIG. 18 shows soft tissue attachment device 700. Device 700 is similarto device 100 save for the apparatus used to attach device 700 to aprosthesis. Similar to device 100, device 700 includes body 701 whichhas two parts, frame 720 and porous section 710. Body 701 of device 700includes anterior surface 750, posterior surface 751, lateral end 740,and medial end 741. Body 701 includes lateral attachment post 770 whichextends from posterior surface 751 and is located proximate lateral end740. Lateral attachment post 760 includes a plurality of teeth 770extending therefrom. Body 701 also includes medial attachment post 761which extends from posterior surface 751 and is located proximate medialend 741. Medial attachment post 761 includes a plurality of teeth 771extending therefrom. Teeth 770,771 may be ratchets. That is, they mayhave a gently sloping front faces that allow for linear insertion andsteeply angle rear faces that prevent removal. The prosthesis preferablyincludes a complementary set of ratchets disposed in the openings intowhich attachment posts 760, 761 are to be inserted. The maximumdimension of teeth 770, 771 should be larger than the minimum diameterof the corresponding teeth inside the prosthesis. As such, teeth 770,771 are configured to deflect slightly as each pair of teeth pass acomplementary pair of teeth.

FIG. 19 show soft tissue attachment device 800. Device 800 is similar todevice 100 except for the apparatus used to attach device 800 toproximal tibial component 200. Similar to device 100, device 800includes medial attachment post 861. However, device 800 includes medialattachment openings 871 and 873 which extend from anterior surface 850to a posterior surface of medial attachment post 861. Device 800 alsoincludes a lateral attachment post with lateral attachment openingsextending therethrough. Attachment of device 800 is facilitated by cable501. Cable 501 may be made of a woven polymeric material or amonofilament wire. Cable 501 may be first inserted through one of thelateral attachment openings, wrapped around the posterior of proximaltibial component 200, inserted posteriorly through medial attachmentopening 871, inserted anteriorly through medial attachment opening 873,wrapped around the posterior surface of proximal tibial component 200,and inserted posteriorly through the other lateral attachment opening.In such a configuration, leading end and trailing end of cable 501 arelocated adjacent one another. The leading and trailing ends of cable 501may be secured by tying them together using any type of knot sufficientfor creating a permanent connection. Alternatively, the ends of cable501 my be secured by a cable retention device (not shown) affixed tocable 501 adjacent to the lateral attachment openings.

Installation of the soft tissue attachment devices disclosed herein maybe aided by a set of specialized tools (not shown) for accuratelyapplying an appropriate amount of tension to the soft tissue attachmentdevice to maximize grip of the tissue without causing necrosis. Forexample, with regard to device 100 in FIGS. 1A and 1B, a prosthesis mayhave anchor points where the tool temporarily anchors to the prosthesisand applies uniform pressure across anterior surface 150. The tool mayinclude a gauge showing the amount of pressure being applied to the softtissue. The tool may further include a dial to slowly increase theamount of force applied. Once the desired pressure is achieved, setscrews are tightened against flat surfaces 170, 171 to affix device 100to the prosthesis. Such an installation tool enables the surgeon toprecisely apply the correct amount of pressure to the soft tissuewithout fear of creating too much pressure and preventing blood flow inthe soft tissue. A similar tool would be useful for installing devices300, 100E, 100G, 700, 800 of FIGS. 6, 13, 16, 17, 18, 19, respectively.An installation tool useful for devices 100A, 100C, 100D, and 100F wouldinclude a driver that converts the rotational force applied to thescrews into the resulting pressure exerted by the device on the softtissue.

It should be noted that any disclosed embodiment may come preinstalledon a prosthesis and merely has enough space between the posteriorsurface of the device and the anterior surface of the prosthesis inorder to pull the soft tissue between the two surfaces.

Other embodiments of the invention will be apparent to those skilled inthe art from consideration of the specification and practice of theinvention disclosed herein. It is intended that the embodimentsdescribed below be considered as exemplary only, with a true scope andspirit of the invention being indicated by the appended claims.Moreover, none of the features disclosed in this specification should beconstrued as essential elements, and therefore, no disclosed featuresshould be construed as being part of the claimed invention unless thefeatures are specifically recited in the claims. In addition, it shouldbe understood that any of the features disclosed on any particularembodiment may be incorporated in whole or in part on any of the otherdisclosed embodiments.

We claim:
 1. A device for fixation of soft tissue comprising: a bodyhaving an anterior surface, a posterior surface, and a depth extendingfrom the anterior surface to the posterior surface, the body furtherhaving a distal end, a proximal end, and a height extending from thedistal end to the proximal end, the body further having a lateral end, amedial end, and a width extending from the lateral end to the medialend, the posterior surface having a concave portion that generallymatches a convex portion of an anterior surface of a prosthetic implant,the body further comprising: a frame having a solid perimeter; a poroussection disposed within the solid perimeter of the frame, wherein theporous section extends through the depth of the body so the anteriorsurface is in communication with the posterior surface through theporous section, and wherein the porous section extends across a majorityof the height and the width of the body; a lateral attachment postextending from the posterior surface proximate the lateral end, thelateral attachment post having a flat surface for engagement with alateral set screw, the lateral attachment post being configured to fitwithin a lateral attachment opening in the prosthetic implant; and amedial attachment post extending from the posterior surface proximatethe medial end, the medial attachment post having a flat surface forengagement with a medial set screw, the medial attachment post beingconfigured to fit within a medial attachment opening in the prostheticimplant.
 2. The device of claim 1, wherein the porous section generallyincludes a pore size of about 500-700 microns.
 3. The device of claim 1,further comprising a means for attaching soft tissue of a patient to aprosthetic implant.
 4. The device of claim 1, wherein the posteriorsurface of the device further includes a roughened surface.
 5. Thedevice of claim 1, wherein the porous section is supported by a latticestructure.
 6. The device of claim 5, wherein the lattice structure iscomprised of generally vertical and horizontal strips.
 7. The device ofclaim 1, wherein the frame and the porous section are differentmaterials.
 8. The device of claim 1, wherein the porous section is anordered or random geometric structure.
 9. The device of claim 1, whereinthe porous section comprises a biocompatible polymer.
 10. A tibialorthopedic implant, the implant comprising: a proximal tibial componentconfigured to attach to and extend from a resected proximal tibia, theproximal tibial component comprising; a body having an anterior surface,a posterior surface, a medial side, a lateral side, a distal end, and aproximal end, the anterior surface including a porous section configuredto allow tissue ingrowth, the porous section having a convex curvatureextending from proximate the medial side to proximate the lateral side,the body further including a plurality of openings adjacent the poroussection; and an articulation component configured to attach to theproximal end of the body, the articulation component including a bearingsurface configured to bear against a distal femoral implant; and a softtissue attachment device including an anterior surface, a posteriorsurface, and a depth extending from the anterior surface to theposterior surface, the soft tissue attachment device further including adistal end, a proximal end, and a height extending from the distal endto the proximal end, the soft tissue attachment device further includinga lateral end, a medial end, and a width extending from the lateral endto the medial end, the posterior surface having a concave portion thatgenerally matches the convex curvature of the porous section of the bodyof the proximal tibial component, the soft tissue attachment devicefurther comprising: a frame having a solid perimeter; a porous sectiondisposed within the solid perimeter of the frame, wherein the poroussection extends through the depth of the soft tissue attachment deviceso the anterior surface is in communication with the posterior surfacethrough the porous section, and wherein the porous section extendsacross a majority of the height and the width of the soft tissueattachment device; a lateral attachment opening in the anterior surfaceof the body adjacent a lateral edge of the porous section; a medialattachment opening in the anterior surface of the body adjacent a medialedge of the porous section; a threaded lateral set screw opening incommunication with the lateral attachment opening; and a threaded medialset screw opening in communication with the medial attachment opening.11. The implant of claim 10, wherein the frame and the porous sectionare different materials.
 12. The implant of claim 10, wherein the poroussection comprises a biocompatible polymer.
 13. The implant of claim 10,wherein the soft tissue attachment device further comprises: a lateralattachment post extending from the posterior surface proximate thelateral end, the lateral attachment post having a flat surfaceconfigured for engagement with a lateral set screw introducible throughthe threaded lateral set screw opening, the lateral attachment postbeing configured to fit within the lateral attachment opening; and amedial attachment post extending from the posterior surface proximatethe medial end, the medial attachment post having a flat surfaceconfigured for engagement with a medial set screw introducible throughthe threaded medial set screw opening, the medial attachment post beingconfigured to fit within the medial attachment opening.
 14. The implantof claim 10, wherein the porous section of the proximal tibial componentgenerally includes a pore size of about 500-700 microns.
 15. The implantof claim 10, further comprising a means for attaching soft tissue of apatient to the proximal tibial component.
 16. The device of claim 10,wherein the posterior surface of the soft tissue attachment devicefurther includes a roughened surface.
 17. The implant of claim 10,wherein the proximal tibial component further comprises: a secondlateral attachment opening in the anterior surface of the body adjacenta lateral edge of the porous section; a second medial attachment openingin the anterior surface of the body adjacent a medial edge of the poroussection; a second threaded lateral set screw opening in communicationwith the second lateral attachment opening; and a second threaded medialset screw opening in communication with the second medial attachmentopening.
 18. The device of claim 10, wherein the porous section issupported by a lattice structure.
 19. The device of claim 18, whereinthe lattice structure is comprised of generally vertical and horizontalstrips.
 20. A device for fixation of soft tissue, the device comprising:a body having an anterior surface, a posterior surface, and a depthextending from the anterior surface to the posterior surface, the bodyfurther having a distal end, a proximal end, and a height extending fromthe distal end to the proximal end, the body further having a lateralend, a medial end, and a width extending from the lateral end to themedial end, the posterior surface having a concave portion thatgenerally matches a convex portion of an anterior surface of aprosthetic implant, the body further comprising: a frame having a solidperimeter; a porous section having a lattice structure disposed withinthe solid perimeter of the frame, wherein the porous section extendsthrough the depth of the body so the anterior surface is incommunication with the posterior surface through the porous section,wherein the porous section extends across a majority of the height andthe width of the body, wherein the porous section comprises abiocompatible polymer, and wherein the lattice structure is comprised ofgenerally vertically and horizontally aligned strips; a lateralattachment post extending from the posterior surface proximate thelateral end, the lateral attachment post having a flat surface forengagement with a lateral set screw, the lateral attachment post beingconfigured to fit within a lateral attachment opening in the prostheticimplant; and a medial attachment post extending from the posteriorsurface proximate the medial end, the medial attachment post having aflat surface for engagement with a medial set screw, the medialattachment post being configured to fit within a medial attachmentopening in the prosthetic implant.